Long term health conditions management and learning disabilities

Management of long term health conditions amongst adults with learning disabilities in primary care settings

Background

People with learning disabilities face barriers in accessing health services, compounded by communication difficulties, and organisational and social support limitations. As a result, this may contribute to the poorer health and higher levels of multi-morbidity experienced by people with learning disabilities in comparison to the general population. In order to reduce inequities, primary health care providers need to effectively manage long-term conditions in keeping with best practice. However, current evidence suggests this may not always occur. This project measured the management of long-term conditions within primary health care for adults with learning disabilities, and compared this with the general population. Additionally we investigated the number of recognised health conditions experienced by adults with learning disabilities compared with the general population, and the potential influence of a range of individual, social and environmental factors upon these health problems.

Method

In the UK, general practitioners/family physicians receive pay for performance on management of long-term conditions, according to best-practice indicators. These indicators are specified in the general practitioners’ contract (the “Quality and Outcomes Framework”). The primary health care records of a population based cohort of adults with learning disabilities were scrutinised to determine performance on management of long-term conditions according to Quality and Outcomes Framework indicators. Management of long‐term conditions was compared between 721 adults with intellectual disabilities and the general population (n = 764,672). Prevalence of long‐term conditions was determined, and associated factors were investigated via logistic regression analyses.

Results

Adults with intellectual disabilities received significantly poorer management of all long‐term conditions on 38/57 (66.7%) indicators. Achievement was high (75.1%–100%) for only 19.6% of adults with intellectual disabilities, compared with 76.8% of the general population. Adults with intellectual disabilities had higher rates of epilepsy, psychosis, hypothyroidism, asthma, diabetes and heart failure. There were no clear associations with neighbourhood deprivation.

Conclusions

Adults with intellectual disabilities receive poorer care, despite conditions being more prevalent. The imperative now is to find practical, implementable means of supporting the challenges that general practices face in delivering equitable care.

Management of long-term conditions in primary health care for adults with learning disabilities compared with the general population: a comparison over time

Background

The UK general practitioners contract included a pay for performance element for management of long-term conditions, according to best-practice indicators, defined by the Quality and Outcomes Framework (QOF). This study uses QOF to measures good practice for adults with learning disabilities compared with the general population at two time points.

Method

Patient records of adults with learning disabilities registered with participating general practices were extracted and analysed in 2010 (n=721) and in 2014 (n=4,066) to determine management of long-term conditions according to QOF indicators. Comparisons at both times were made with the general population from the same health board. Additionally, prevalence of long term conditions was determined, and associations with age, gender, ability, type of accommodation, and neighbourhood deprivation were investigated via logistic regression analyses.

Results

Adults with learning disabilities received poorer management of long–term conditions compared to the general population on 53/57 (92.9%) indicators in 2010, and 38/54 (70.4%) indicators in 2014. Improvements were found at 2014 as achievement was high (76-100%) for 19.6% of adults with learning disabilities in 2010, compared to 74.1% in 2014. Adults with learning disabilities had higher rates of epilepsy, psychosis, hypothyroidism, asthma, diabetes, and heart failure; with little association with ability, accommodation-type or neighbourhood deprivation.

Conclusions

High quality management of long term conditions is essential to maintain and improve health. The healthcare inequality gap between people with learning disabilities and the general population narrowed between 2010 and 2014, though people with learning disabilities still experienced poorer management of their long term conditions.